• Spontaneous hemothorax is uncommon.
• Small-volume aspiration and analysis precede complete drainage.
• Hypovolemia is life threatening in acute large-volume drainage.
• Arrange for rapid transfusion prior to draining hemothorax.
• Acute massive hemothorax should be managed in an operating area before drainage, where time permits.
• Small-volume hemothorax in a stable patient may lead to a better outcome if managed conservatively rather than repeatedly aspirated or drained.
• Thoracoscopy should only be carried out by experienced personnel.
• Thoracotomy can add to morbidity if carried out by the inexperienced.
• A bag with a valve can be an alternative to an underwater-seal bottle.
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